Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations
Reamputation, mortality, and health care costs among persons with dysvascular lower-limb amputations
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DOI：
10.1016/j.apmr.2004.06.072
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发表时间：
2005-03-01
影响因子：
4.3
通讯作者：
Shore, AD
中科院分区：
文献类型：
--
作者：
Dillingham, TR;Pezzin, LE;Shore, AD
目的：研究12个月的再截肢率和死亡率，以及急性和急性后的医疗护理费用在一个大队列的人与血管障碍截肢。设计：回顾性队列研究。设置：一般社区。参与者：医疗保险受益人确定从医疗保险和医疗补助服务中心的数据，因为在1996年进行下肢截肢继发于血管疾病。干预措施：不适用。主要结果措施：12个月截肢和死亡率，急性和急性后的医疗费用，由最初的截肢水平和存在或不存在的diabetes.Results：共3565人，对应于71,300医疗保险受益人在全国范围内，被确定为在1996年进行下肢截肢的索赔数据。其中26%的患者需要在12个月内进行后续截肢手术，超过三分之一的患者在首次截肢后1年内死亡。与照顾血管障碍截肢受益人相关的急性和急性后医疗护理费用每年超过43亿美元。在合并糖尿病和不合并糖尿病的血管障碍截肢者中，患者特征、截肢进展到更高水平、服务使用和死亡率有显著差异。糖尿病截肢者比非糖尿病截肢者更年轻;他们也更可能是男性，有更多的合并症，并且比没有糖尿病的血管障碍截肢者更早接受首次截肢。虽然糖尿病截肢者在指数截肢后12个月内死亡的可能性较小，但他们的死亡年龄明显低于非糖尿病截肢者。进展到更高水平的肢体丧失最常见（34.5%）的人与最初的脚或踝关节截肢。糖尿病截肢者比非糖尿病截肢者更有可能经历进展到一个更高的截肢水平为所有初始截肢levels.Conclusions：这项研究提供的信息，可用于医生咨询时，患者的预期结果，在不同水平的血管障碍截肢。(C)2005年由美国康复医学大会和美国物理医学与康复学院。
Objectives: To examine 12-month reamputation and mortality rates as well as acute and postacute medical care costs among a large cohort of persons with dysvascular amputations.Design: Retrospective cohort study.Setting: General community.Participants: Medicare beneficiaries identified from the Centers for Medicare and Medicaid Services data as undergoing a lower-limb amputation secondary to vascular disease in 1996.Interventions: Not applicable.Main Outcome Measures: Twelve-month reamputation and mortality rates, and acute and postacute medical care costs, by initial amputation level and presence or absence of diabetes.Results: A total of 3565 persons, corresponding to 71,300 Medicare beneficiaries nationwide, were identified from the claims data as undergoing lower-limb amputations in 1996. Twenty-six percent of them required subsequent amputation procedures within 12 months, and more than one third died within 1 year of their index amputation. Acute and postacute medical care costs associated with caring for beneficiaries with a dysvascular amputation exceeded $4.3 billion yearly. There were marked differences in patient characteristics, progression of amputation to higher levels, service use, and mortality among dysvascular amputees with and without a comorbidity of diabetes. Diabetic amputees were younger than those without diabetes; they were also more likely to be men, to have more comorbidities, and to have undergone their first amputation at an earlier age than persons with dysvascular amputations who did not have diabetes. Although diabetic amputees were less likely to die within 12 months of the index amputation, they died at a significantly younger age than their nondiabetic counterparts. Progression to a higher level of limb loss occurred most frequently (34.5%) among persons with an initial foot or ankle amputation. Diabetic amputees were more likely than nondiabetic amputees to experience progression to a higher amputation level for all initial amputation levels.Conclusions: This study provides information that can be used by physicians when counseling patients about expected outcomes of dysvascular amputations at different levels. (C) 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.